John Wallace

NPI #1053126706 in Ralston, Nebraska

Provider Information

NPI Number: 1053126706
Entity Type: Individual
Name: John Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Feb 10, 2025
Last Updated: Feb 11, 2025

Practice Location

Address: 6732 S 73RD STREET CIR
City: Ralston
State: Nebraska
ZIP Code: 68127-4387
Phone: (531) 772-8700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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